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Schizophrenia and bipolar disorder are characterized by social cognitive impairments, and recent research has identified alterations of the social brain. However, it is unknown whether familial high risk (FHR) of these disorders is associated with neurobiological alterations already present in childhood.

The forced temporary relocation of part of a Danish neonatal intensive care unit (NICU) offered a unique opportunity to address the study aim of examining the real-time experiences of parents and nurses with SFRs.

The proxies used to compose cognitive reserve (CR) for patients of a first episode of psychosis (FEP) have varied in the literature. The development of FEP is linked to peripheral pathways of the central nervous system, yet despite this knowledge, no research has considered the introduction of biomarkers as proxies for CR. Meanwhile, schizophrenia has been linked to the metabolic system, indicating that alterations in the levels of biological parameters, in particular high-density lipoproteins (HDL), cause worse global functioning and cognitive impairment. For these reasons, the present study aimed to create a quantifiable and objective CR index that adjusts for the multifactorial nature of FEP.

ObjectivesFew studies have examined whether access to, and quality of, specialised palliative care changed during the COVID-19 pandemic. This study investigated changes in access to and quality of specialised palliative care during the pandemic in Denmark compared to previously.MethodsAn observational study using data from the Danish Palliative Care Database combined with other nationwide registries was conducted, including 69 696 patients referred to palliative care services in Denmark from 2018 to 2022. Study outcomes included number of referrals and admissions to palliative care, and the proportions of patients fulfilling four palliative care quality indicators. The indicators assessed admissions among referred, waiting time from referral to admission, symptom screening using the European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire at admission, and discussion at multidisciplinary conference. Logistic regression analysed whether the probability of fulfilling each indicator differed between the pandemic period and pre-pandemic, while adjusting for possible confounders.ResultNumber of referrals and admissions to specialised palliative care were lower during the pandemic. The odds for being admitted within 10 days of referral was higher during the pandemic (OR: 1.38; 95% CI: 1.32 to 1.45) whereas the odds for answering the EORTC questionnaire (0.88; 95% CI: 0.85 to 0.92) and for being discussed at multidisciplinary conference (0.93; 95% CI: 0.89 to 0.97) were lower compared with pre-pandemic.ConclusionsFewer patients were referred to specialised palliative care during the pandemic, and fewer were screened for palliative care needs. In future pandemics or similar scenarios, it is important to pay special attention to referral rates and to maintain the same high level of specialised palliative care.

Clinical sleep analysis require manual analysis of sleep patterns for correct diagnosis of sleep disorders. However, several studies have shown significant variability in manual scoring of clinically relevant discrete sleep events, such as arousals, leg movements, and sleep disordered breathing (apneas and hypopneas). We investigated whether an automatic method could be used for event detection and if a model trained on all events (joint model) performed better than corresponding event-specific models (single-event models). We trained a deep neural network event detection model on 1653 individual recordings and tested the optimized model on 1000 separate hold-out recordings. F1 scores for the optimized joint detection model were 0.70, 0.63, and 0.62 for arousals, leg movements, and sleep disordered breathing, respectively, compared to 0.65, 0.61, and 0.60 for the optimized single-event models. Index values computed from detected events correlated positively with manual annotations (r2 = 0.73, r2 = 0.77, r2 = 0.78, respectively). We furthermore quantified model accuracy based on temporal difference metrics, which improved overall by using the joint model compared to single-event models. Our automatic model jointly detects arousals, leg movements and sleep disordered breathing events with high correlation with human annotations. Finally, we benchmark against previous state-of-the-art multi-event detection models and found an overall increase in F1 score with our proposed model despite a 97.5% reduction in model size.

Objectives: To examine costs of care from a healthcare sector perspective within 1 year before death in patients with non-cancer diseases and patients with cancer. Methods: This nationwide registry-based study identified all Danish citizens dying from major non-cancer diseases or cancer in 2010–2016. Applying the cost-of-illness method, we included costs of somatic hospitals, including hospital-based specialist palliative care, primary care, prescription medicine and hospice expressed in 2022 euros. Costs of patients with non-cancer diseases and cancer were compared using regression analyses adjusting for sex, age, comorbidity, residential region, marital/cohabitation status and income level. Results: Within 1 year before death, mean total healthcare costs were €27,185 [95% confidence interval (CI) €26,970–27,401] per patient with non-cancer disease (n= 109,723) and €51,348 (95% CI €51,098–51,597) per patient with cancer (n= 108,889). The adjusted relative total healthcare costs, i.e. the ratio of the mean costs, of patients with non-cancer diseases was 0.64 (95% CI 0.63–0.66) at 12 months before death and 0.91 (95% CI 0.90–0.92) within 30 days before death compared with patients with cancer. Conclusions: Within 1 year before death, total healthcare costs, mainly driven by hospital costs, were substantially lower for patients with non-cancer diseases compared with patients with cancer. Moreover, the costs of hospital-based specialist palliative care and hospice were minimal for patients with non-cancer diseases.

Glioblastoma presents a formidable clinical challenge because of its complex microenvironment. Here, we characterized tumor-associated foam cells (TAFs), a type of lipid droplet–loaded macrophage, in human glioblastoma. Through extensive analyses of patient tumors, together with in vitro and in vivo investigations, we found that TAFs exhibit distinct protumorigenic characteristics related to hypoxia, mesenchymal transition, angiogenesis, and impaired phagocytosis, and their presence correlates with worse outcomes for patients with glioma. We further demonstrated that TAF formation is facilitated by lipid scavenging from extracellular vesicles released by glioblastoma cells. We found that targeting key enzymes involved in lipid droplet formation, such as diacylglycerol O-acyltransferase or long-chain acyl-CoA synthetase, effectively disrupted TAF functionality. Together, these data highlight TAFs as a prominent immune cell population in glioblastoma and provide insights into their contribution to the tumor microenvironment. Disrupting lipid droplet formation to target TAFs may represent an avenue for future therapeutic development for glioblastoma.

Cette étude randomisée, multicentrique, menée en ouvert et cross-over, a évalué la préférence et la facilité d’utilisation du stylo injecteur somapacitan vs somatrogon.

Clinical event debriefing (CED) can improve patient care and outcomes, but little is known about CED across inpatient settings, and participant experiences have not been well described. In this qualitative study, we sought to characterize and compare staff experiences with CED in 2 hospital units, with a goal of generating recommendations for a hospital-wide debriefing program.We conducted 32 semistructured interviews with clinical staff who attended a CED in the previous week. We explored experiences with CED, with a focus on barriers and facilitators. We used content analysis with constant comparative coding to understand priorities identified by participants. We used inductive reasoning to develop a set of CED practice recommendations to match participant priorities.Three primary themes emerged related to CED barriers and facilitators. (1) Factors affecting attendance: most respondents voiced a need for frontline staff inclusion in CED, but they also cited competing clinical duties and scheduling conflicts as barriers. (2) Factors affecting participant engagement: respondents described factors that influence participant engagement in reflective discussion. They described that the CED leader must cultivate a psychologically safe environment in which participants feel empowered to speak up, free from judgment. (3) Factors affecting learning and systems improvement: respondents emphasized that the CED group should generate a plan for improvement with accountable stakeholders. Collectively, these priorities propose several recommendations for CED practice, including frontline staff inclusion.In this study, we propose recommendations for CED that are derived from first-hand participant experiences. Future study will explore implementation of CED practice recommendations.

INTRODUCTION: Acne often persists into adulthood in women. However, few studies have specifically explored the lived experience of acne in adult populations. OBJECTIVE: To examine the lived experience of acne and its treatment among a cohort of adult women. DESIGN, SETTING, AND PARTICIPANTS: A qualitative analysis was conducted from free listing and open-ended, semistructured interviews of patients at a large academic health care system (University of Pennsylvania Health System) and a private practice (Dermatologists of Southwest Ohio). Fifty women 18 to 40 years of age with moderate to severe acne participated in interviews conducted between August 30, 2019, and December 31, 2020. MAIN OUTCOMES AND MEASURES: Free-listing data from interviews were used to calculate the Smith S, a measure of saliency for each list item. Semistructured interviews were examined to detect themes about patient perspectives regarding their acne and its treatment. RESULTS: Fifty participants (mean [SD] age, 28 [5.38] years; 24 [48%] White) described acne-related concerns about their appearance that affected their social, professional, and personal lives, with many altering their behavior because of their acne. Depression, anxiety, and social isolation were commonly reported. Participants described successful treatment as having completely clear skin over time or a manageable number of blemishes. Many participants described frustration with finding a dermatologist with whom they were comfortable and with identifying effective treatments for their acne. CONCLUSIONS AND RELEVANCE: The results of this qualitative study suggest that women with acne have strong concerns about appearance and experience mental and emotional health consequences and disruption of their personal and professional lives. In addition, many patients describe challenges finding effective treatments and accessing care. Future trials to understand the optimal treatment approaches for women with acne are needed to improve outcomes in this population.

Quantum computing can be realized with numerous different hardware platforms and computational protocols. A highly promising, and potentially scalable, idea is to combine a photonic platform with measurement-induced quantum information processing. In this approach, gate operations can be implemented through optical measurements on a multipartite entangled quantum state—a so-called cluster state. Previously, a few quantum gates on non-universal or non-scalable cluster states have been performed, but a full set of gates for universal scalable quantum computing has not been realized. Here we propose and demonstrate the deterministic implementation of a multi-mode set of measurement-induced quantum gates in a large two-dimensional optical cluster state using phase-controlled continuous-variable quadrature measurements. Each gate is programmed into the phases of high-efficiency quadrature measurements, which execute the transformations by teleportation through the cluster state. We further execute a small quantum circuit consisting of 10 single-mode gates and 2 two-mode gates on a three-mode input state. Fault-tolerant universal quantum computing is possible with this platform if the cluster-state entanglement is improved and a supply of states with Gottesman–Kitaev–Preskill encoding is available.

BackgroundFew studies have investigated the content of interventions provided in early specialised palliative care (SPC).ObjectivesTo characterise the content of interventions delivered in early SPC in the Danish Palliative Care Trial (DanPaCT), a multicentre trial with six participating sites.MethodsA retrospective qualitative and quantitative study coding all new interventions initiated by the palliative teams and documented in the medical records during the 8-week study period of DanPaCT. Interventions were categorised according to (a) symptom/problem prompting the intervention, (b) type of intervention and (c) professional(s) providing the intervention.ResultsIn total, 145 patients were randomised to the SPC teams. According to the medical records, patients received a median of 3.5 (range 0–22) new interventions in the 8-week intervention-period from the palliative teams. For 24 (18%) of the patients there was no documented interventions in the medical records. The most frequent symptom/problems treated were pain, (100 interventions; 20% of interventions given) and impaired physical function (62; 13% of interventions given). The most frequent type of intervention was pharmacological (232; 42% of interventions given).ConclusionsThis is one of the first studies to meticulously investigate the content of interventions documented in the medical records for patients receiving early SPC. Diverse symptoms were treated with many different interventions. However, a relatively low number of interventions were documented. This may explain the lack of effect in DanPaCT but also questions whether all interventions were adequately documentedTrial registration numberNCT01348048

Networking is integral to quantum communications1and has significant potential for upscaling quantum computer technologies2. Recently, it was realized that the sensing performances of multiple spatially distributed parameters may also be enhanced through the use of an entangled quantum network3–10. Here, we experimentally demonstrate how sensing of an averaged phase shift among four distributed nodes benefits from an entangled quantum network. Using a four-mode entangled continuous-variable state, we demonstrate deterministic quantum phase sensing with a precision beyond what is attainable with separable probes. The techniques behind this result can have direct applications in a number of areas ranging from molecular tracking to quantum networks of atomic clocks.

The four-component cat state represents a particularly useful quantum state for realizing fault-tolerant continuous variable quantum computing. While such encoding has been experimentally generated and employed in the microwave regime, the states have not yet been produced in the optical regime. Here, we propose a simple linear optical circuit combined with photon counters for the generation of such optical four-component cat states. This work might pave the way for the first experimental generation of fault-tolerant optical continuous variable quantum codes.

IMPORTANCE: Epicardial and pericardial adipose tissues are emerging as important risk factors for cardiovascular disease, and there is a growing interest in discovering strategies to reduce the accumulation of fat in these depots. OBJECTIVE: To investigate whether a 12-week endurance or resistance training intervention regulates epicardial and pericardial adipose tissue mass. DESIGN, SETTING, AND PARTICIPANTS: Secondary analysis of a randomized, assessor-blinded clinical trial initiated on August 2016 and completed April 2018. This single-center, community-based study included 50 physically inactive participants with abdominal obesity. INTERVENTIONS: Participants were randomized to a supervised high-intensity interval endurance training (3 times a week for 45 minutes), resistance training (3 times a week for 45 minutes), or no exercise (control group). MAIN OUTCOMES AND MEASURES: Change in epicardial and pericardial adipose tissue mass assessed by magnetic resonance imaging, based on a prespecified secondary analysis plan including 3 of 5 parallel groups. RESULTS: Of 50 participants (mean [SD] age, 41 [14] years, 10 men [26%]; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 32 [5]), 39 [78%] completed the study. Endurance training and resistance training reduced epicardial adipose tissue mass by 32% (95% CI, 10%-53%) and 24% (95% CI, 1%-46%), respectively, compared with the no exercise control group (56% [95% CI, 24%-88%]; P = .001 and 48% [95% CI, 15%-81%]; P < .001, respectively). While there was a nonsignificant reduction in pericardial adipose tissue mass after endurance training (11% [95% CI, −5% to 27%]; P = .17), resistance training significantly reduced pericardial adipose tissue mass by 31% (95% CI, 16%-47%; P < .001) when compared with the no exercise control group. Compared with the no exercise control group, there was an increase in left ventricular mass by endurance (20 g [95% CI, 11%-30%]; P < .001) and resistance training (18 g [95% CI, 8%-28%]; P < .001). Other cardiometabolic outcomes remained unchanged after the 12-week trial period. CONCLUSIONS AND RELEVANCE: In individuals with abdominal obesity, both endurance and resistance training reduced epicardial adipose tissue mass, while only resistance training reduced pericardial adipose tissue mass. These data highlight the potential preventive importance of different exercise modalities as means to reduce cardiac fat in individuals with abdominal obesity. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02901496

Background:Advance care planning (ACP) has been suggested to improve the quality of life (QoL) and mental wellbeing in severely ill patients and their relatives.Aim:To investigate the effects of ACP among patients with lung, heart and cancer diseases with an estimated life-span of up to 12 months.Methods:Patients and relatives were randomised into two groups: one receiving usual care and one receiving ACP and usual care. Themes from the ACP discussion were documented in patients' electronic medical file. Participants completed self-reported questionnaires four to five weeks after randomisation.Findings:In total, 141 patients and 127 relatives participated. No significant differences were found according to outcomes. However, patients with non-malignant diseases had the highest level of anxiety and depression; these patients seemed to benefit the most from ACP, though not showing statistically significant results.Conclusion:No significant effects of ACP among patients with lung, heart, and cancer diseases and their relatives regarding HRQoL, anxiety, depression, and satisfaction with healthcare were found.

This special issue seeks to investigate and understand the various experiences of asylum-seekers, beneficiaries of subsidiary protection and refugees in accessing labour markets across the EU and EEA countries. The first section of this introduction provides an overview of the three groups of people who are the focus of this special issue and their relationship to the labour markets in the EU Member States and EEA countries. The second section provides insights into how the essential features of their labour market integration may be understood by using Levitas’ discourse analysis. The third section explores a range of different labour market access dimensions by focusing not only on the human capital aspects of migration in general but also on the contextual factors of civic stratification; the broader societal context, including public opinion and civil society; the background and situation of earlier migrants, especially asylum-seekers and refugees with respect to national/federal laws; and the countries of origin of migrants as well as demographic trends across the EU. The fourth and final section explains and justifies the focus of this special issue and emphasises the relevance of this topic.

Medication nonadherence is a leading cause of graft loss. Adherence monitoring technologies—reminder texts, smart bottles, video-observed ingestion, and digestion-activated signaling pills—may support adherence. However, patient, care partner, and clinician perceptions of these tools are not well studied. We conducted qualitative individual semistructured interviews and focus groups among 97 participants at a single center: kidney and liver transplant recipients 2 weeks to 18 months posttransplant, their care partners, and transplant clinicians. We assessed adherence practices, reactions to monitoring technologies, and opportunities for care integration. One-size-fits-all approaches were deemed infeasible. Interviewees considered text messages the most acceptable approach; live video checks were the least acceptable and raised the most concerns for inconvenience and invasiveness. Digestion-activated signaling technology produced both excitement and apprehension. Patients and care partners generally aligned in perceptions of adherence monitoring integration into clinical care. Key themes were importance of routine, ease of use, leveraging technology for actionable medication changes, and aversion to surveillance. Transplant clinicians similarly considered text messages most acceptable and video checks least acceptable. Clinicians reported that early posttransplant use and real-time adherence tracking with patient feedback may facilitate successful implementation. The study provides initial insights that may inform future adherence technology implementation.

Background:Despite treatment safety and efficacy advancements for children with hemophilia (CwH), home treatment can be complicated and burdensome. Treatment burdens are major contributing factors to adherence issues.

Background:Currently available hemophilia treatments have resulted in significant improvements in quality of life. However, children with hemophilia (CwH) may still experience considerable treatment burden due to technical, physical, logistical, and emotional aspects of treatment administration.

Children of parents with severe mental illness have several known risk factors for altered pubertal timing. Pubertal timing is important for children’s physical and emotional development. We aimed to examine pubertal timing and associations between pubertal timing, early life adversity and child problem behavior including psychiatric diagnoses among children of parents with schizophrenia or bipolar disorder and controls.

BackgroundIn Denmark, patients who are terminally ill have the right to drug reimbursement due to terminal illness (DRTI). DRTI, a proxy marker of planned end-of-life care, is intended to be equally accessible regardless of socioeconomic position. This study examined social and socioeconomic differences in DRTI among Danish patients who are terminally ill.MethodsThis cross-sectional study based on individual-level nationwide data included all patients dying from cancer, dementia, ischaemic heart disease, chronic obstructive pulmonary disease, chronic liver disease, congestive heart failure, diabetes or stroke in 2006–2015 (n=307 188). We analysed associations between social and socioeconomic position (education, income, cohabiting status, migrant status and employment) and DRTI. Prevalence ratios (PR) and 95% CIs were estimated using log-linear models adjusted for age, gender, comorbidity, cause of death and residence.ResultsOverall, 27.9% of patients received DRTI (n=85 616). A substantial difference in likelihood of receiving DRTI was observed among patients with a social and socioeconomic profile associated with the highest versus lowest probability of DRTI (adjusted PR 1.44, 95% CI 1.18 to 1.75). The probability of DRTI was higher among patients with high income compared with low income (adjusted PR 1.22, 95% CI 1.17 to 1.26). Also, living with a partner and being immigrant or descendant of such were associated with higher probability of DRTI compared with living alone and of Danish origin, whereas employment was associated with lower probability of DRTI compared with retirement.ConclusionSocial and socioeconomic position was associated with the likelihood of receiving DRTI, which indicates that planned end-of-life care is not equally accessible in Denmark.

Osteopontin (OPN) is a multifunctional protein expressed in many cell types, tissues and body fluids with the highest concentrations found in milk; significantly higher in human than in bovine milk. Intervention studies have indicated beneficial effects of supplementing infant formula with bovine OPN. In this multicenter study, we determined the OPN content in human milk samples from 629 Chinese, Danish, Japanese and Korean mothers. At each study site, milk samples were collected and analyzed for OPN and protein concentration using ELISA and infrared spectroscopy, respectively. A total of 829 milk samples from 629 women were included. When delivering the first sample, mean maternal age was 31.4 years (SD 4.0), and median infant age was 13.4 weeks (interquartile range 4.6–17.9). The median OPN concentration varied across sites; from 99.7 mg/L in Danish, 185.0 mg/L in Japanese, 216.2 mg/L in Korean to 266.2 mg/L in Chinese mothers (P< 0.001), corresponding to 1.3%, 2.4%, 1.8% and 2.7% of the total protein content (OPN/protein%) (P< 0.05), respectively. Based on 75 Chinese and 33 Japanese mothers delivering more than 1 sample, multilevel (mixed model) linear regression analysis showed a decrease in OPN concentration with infant age (ß = (-11.3), 95% confidence interval (CI) = (-13.9) to (-8.8) and ß = (-2.1), 95% CI = (-3.2) to (-0.9), respectively). In this large multicenter study, we observed statistically significant differences in the OPN concentration and the OPN/protein% in human milk samples between countries. Based on mothers delivering more than 1 sample, a significant decrease within the lactation period was observed.

Background/Context Researchers have found that teachers’ effectiveness at increasing student achievement improves during the first few years on the job. Yet little research maps the trajectory of beginning teachers’ instructional quality or investigates what forms of support are associated with variation in this trajectory. Further, although beginning teachers face many challenges not directly related to the rigor of their instruction, such as classroom management, effectively implementing high-quality instruction remains a major challenge.Purpose/Objective/Research Question/Focus of Study This article focuses on five research questions: (a) What are the initial levels of beginning seventh- and eighth-grade teachers’ mathematics instructional quality? (b) To what extent are teachers’ preservice qualifications (e.g., major; mathematics knowledge for teaching), prior teaching experience (e.g., weeks of student teaching), and school teaching context (e.g., percent of student receiving free or reduced price lunch) associated with the quality of their instruction during their first semester of teaching? (c) What are the levels of, and changes in, organizational supports for math instruction that these teachers receive during their first three years in the profession? (d) To what extent does the instructional quality of beginning middle school math teachers change over their first three years of teaching? and (e) To what extent do content-focused supports (e.g., math-focused mentoring, math-focused PD, professional community, principal leadership) provided over these three years predict improvement in instructional quality?Population/Participants/Subjects Participants include 62 teachers from eight southeastern and three northeastern districts in the United States.Research Design Using observation, survey, and interview data, we identify the links between the organizational supports provided beginning teachers and the teachers’ improvements in instructional quality during their first three years of teaching.Findings/Results Results suggest little improvement in the instructional quality of mathematics lessons during the first three years of teaching and that most organizational supports, as they are currently delivered, do not appear to help beginning middle school mathematics teachers improve their instructional quality. Using in-depth case studies, we explore the nature of the supports provided and their potential links to teacher improvement.Conclusions/Recommendations Our quantitative findings suggest that current methods of supporting beginning middle school mathematics teachers are not robust enough to support the type of teacher improvement demanded by new math standards, although our qualitative analyses suggest ways of designing these supports to better attend to instructional improvement. Our findings also emphasize the critical role the principal can play in connecting new teachers to effective supports.

Background:Asking patients with palliative care needs about their end-of-life (EoL) preferences is widely acknowledged as an important aspect of EoL care. However, the issue of how to ask patients these questions has not been fully explored. Most prior studies in this area do not differentiate between patients' pragmatic preferences and ideal preferences, and between preferences concerning place of care (PoC) and place of death (PoD).Aim:The aim of this study was to examine possible differences between pragmatic and ideal preferences of terminally ill patients, as well as differences between asking patients about preferences concerning PoC and PoD.Methods:Structured interviews were performed with terminally ill cancer patients at inclusion and a follow-up questionnaire was completed 1 month later. Answers were compared using kappa (k) statistics and Pearson's c2–test.Results:Among 96 cancer patients, agreement between pragmatic and ideal preferences was statistically significantly different (p=<0.001). Agreement between preferences for PoC and PoD was high (k:0.76–0.85).Conclusion:Differences exist between pragmatic and ideal EoL preferences, whereas preferences for PoC and PoD were found to be similar. These findings highlight the importance of the phrasing of questions when uncovering patients' preferences for EoL care.

Hyperglycaemia increases the risk of type 2 diabetes, heart disease and stroke, and is influenced by weight. However, the impact of preceding weight change on blood glycemia levels in late-life is less well understood. We studied the interplay between weight change and risk of hyperglycaemia in a prospective cohort of elderly women. Elderly Caucasian women (age: 67.1 years at baseline, n= 1173) enrolled in the Prospective Epidemiological Risk Factor study with baseline and 13-year follow-up measurements of BMI and fasting glucose levels (FPG) and no previous history of diabetes or impaired fasting glucose. Multivariate logistic regression was used to determine risk of hyperglycaemia (FPG ≥ 5.6 mmol/L or HbA1c ≥ 42 mmol/mol) in normalweight (BMI ≤ 25 kg/m2), overweight (BMI = 25–29.9 kg/m2) and obese (BMI ≥ 30 kg/m2) women who either lost weight, were weight-stable or had gained weight at follow-up. Overweight and obese elderly women who had gained weight at follow-up presented an increased risk of hyperglycaemia, OR = 2.7 (1.6–4.6) and OR = 3.2 (1.5–6.8), compared to weight-stable normalweight women. Overweight and obese women who lost weight decreased their risk of hyperglycaemia to a level comparable to weight-stable normalweight women. Overweight and obese women with stable weight presented a two-fold increased risk of hyperglycaemia compared to normalweight weight-stable women. Losing weight in late life had a positive effect on the risk of hyperglycaemia in overweight and obese women, while further, weight gain increased the risk of hyperglycaemia. The study highlights that strategies to reduce weight in obese and overweight elderly women could have a positive influence on disease burden in late-life.

AbstractBackground:Studies on prevalence and effects of breastfeeding call for reliable and precise data collection to optimize infant nutrition, growth, and health. Data on breastfeeding and infant nutrition are at risk of, for example, recall bias or social desirability bias.Objective:The aim of the present analysis was to compare data on infant nutrition, that is, breastfeeding, use of infant formula, and introduction to complementary foods, obtained by four different methods. We assumed that weekly short message service (SMS) questions were the most reliable method, to which the other methods were compared.Design:The study population was part of the Odense Child Cohort. The four methods used were: (a) self-administered questionnaire 3 months postpartum, (b) self-administered questionnaire 18 months postpartum, (c) registrations from health visitors visiting the families several times within the first year of life, and (d) weekly SMS questions introduced shortly after birth.Results:In total, 639 singleton mothers with data from all four methods were included. The proportion of mothers initiating breastfeeding varied from 86% to 97%, the mean duration of exclusive breastfeeding from 12 to 19 weeks, and the mean age when introduced to complementary foods from 19 to 21 weeks. The mean duration of any breastfeeding was 33 weeks across methods.Conclusions:Compared with the weekly SMS questions, the self-administered questionnaires and the health visitors' reports resulted in a greater proportion of mothers with an unknown breastfeeding status, a longer duration of exclusive breastfeeding and later introduction to complementary foods, while the duration of any breastfeeding did not differ.

Learning is related to the environment created for the learning experience. This environment is often highly routinized and involves a certain social structure, but in entrepreneurship education, such routinization and structure may actually counteract the learning goals. This article investigates how classroom routines and rituals impact on entrepreneurship education in order to problematize how existing classroom environments may hinder critical learning experiences from taking place. This article builds on extensive insights from six cohorts of students at two Scandinavian universities over a 4-year period (2012–2015). The data were procured using an experiential–explorative research approach in which the researchers were personally involved in reflective processes as co-learners. The findings illustrate how educators can use rituals actively to change how students learn. However, students are very wary of embracing new structures and rituals; indeed, some feel so comfortable with the old rituals that they would prefer not to change from being receivers of knowledge to co-creators of the learning situation. It is therefore important to exchange existing rituals with new ones that enhance the feeling of safety and involve the students in creating the change. This is achieved through scaffolding and setting up ritual markers, which are continuously repeated.

The vitamin D receptor (VDR) and enzymes involved in activation (CYP2R1, CYP27B1) and inactivation (CYP24A1) of vitamin D are expressed in ovary, testes, and spermatozoa.

BackgroundAdvance care planning (ACP) is a process of discussing and recording patients’ preferences for future care, aiming to guide healthcare decisions at the end of life (EOL).AimTo explore nuances in the long-term impact of ACP by studying patient and relative experiences.DesignA qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis.Setting/participants3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating in an ACP discussion.ResultsThe experiences were diverse. Some patients and relatives felt ‘relieved’, ‘more secure’ and more in control due to ACP. To some, ACP had led to open communication rather than ‘beating around the bush’, and to spending more quality time together. However, others perceived ACP as irrelevant. Some stated that the patient's wishes had not been met regardless of ACP. Others felt that EOL questions cannot be realistically considered until ‘you're in the middle of it’, because many factors are involved. In one case, participating in ACP led to a patient-relative conflict, resulting in EOL issues being ‘tucked away’.ConclusionsThe study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual nature of preferences and needs of patients and relatives regarding information, involvement and communication about EOL care.

The economic crisis has brought the intriguing question of its effects on Social Europe sharply into focus. This contribution therefore goes to the heart of the puzzles and explores the mutual influence of Eurozone reforms and broader Union social policies with an additional focus on pointing out the most pertinent challenges in that regard. Thus, the analysis anchors around the following issues: the social dimension of the EU and the Eurozone respectively; comparison; mutual influence; and challenges. A recurring theme is thus the tension between the overall construction of the EU and the internal construction of the Eurozone, which is growing, but not really focused on. It is, inter alia, concluded that the Eurozone reforms bring Social Europe in a new – also viewed by many as a dangerous, illegitimate and undemocratic – direction detached from the prevailing intentions in the EU as such.

The proxies used to compose cognitive reserve (CR) for patients of a first episode of psychosis (FEP) have varied in the literature. The development of FEP is linked to peripheral pathways of the central nervous system, yet despite this knowledge, no research has considered the introduction of biomarkers as proxies for CR. Meanwhile, schizophrenia has been linked to the metabolic system, indicating that alterations in the levels of biological parameters, in particular high-density lipoproteins (HDL), cause worse global functioning and cognitive impairment. For these reasons, the present study aimed to create a quantifiable and objective CR index that adjusts for the multifactorial nature of FEP.

Background/Context High schools are under increasing pressure to move beyond just graduating students, and many high schools today continue to have low rates of student retention and learning, particularly for students from traditionally low-performing subgroups. Differential dropout rates, wherein low-income students, minorities, and English language learners leave school at higher rates than other students, only compound the problem.Purpose/Objective/Research Question/Focus of Study In this study, we examine differences in instructional quality between two higher and two lower value-added high schools, as measured by the Classroom Assessment Scoring System – Secondary (CLASS-S). It explores (1) differences in levels of instructional quality, (2) differences in the proportions of students taking advanced courses, and (3) differences in the way teachers think and talk about their classroom challenges.Research Design This is a mixed methods study that combines data from classroom observation protocols with teacher interview data. We use multilevel statistical models to address the first two research questions and emergent, inductive coding to determine commonalities within schools in how teachers implement higher-quality instructional practices.Findings/Results We find that the average difference in instructional quality, as measured by the CLASS-S, was not very wide across our four case study schools and that the biggest differences were between the two higher value-added high schools. Our interview data suggest that teachers in the two higher value-added schools are more proactive about providing emotional support and preventing behavioral problems, and intentional about attending to content and engaging students in higher-order thinking.Conclusions/Recommendations The lack of variation in classroom instructional practice across schools also suggests the need to attend to the ways that schools support academic learning outside of the classroom. Qualitative findings signal that the quality of classroom instruction is not the only critical input to students’ learning gains when trying to identify what leads schools to place highly in value-added rankings.

Little is known about the quality of end-of-life care in Danish nursing homes (NHs). This qualitative descriptive study based on semi-structured group interviews with nursing staff members in three NHs in Copenhagen, Denmark, aimed to describe the participants' perceptions of end-of-life care in Danish NHs, with particular focus on medication administration and collaboration with GPs. Four main categories of problematic issues emerged: medication (problems with ‘as needed’ medication and lack of knowledge of subcutaneous administration), interpersonal relations (difficulties in cooperation and communication between relatives and GPs), decision making(problems concerning termination of life-prolonging treatment and the need for early planning of end-of-life care), and professional development (documentation and education). Considerable improvements may be achieved primarily by educating and training nursing staff and GPs. More research is warranted to optimise end-of-life care in Danish NHs.

This paper aims to understand the relationship between households’ livelihood strategy and soil management using commonalities among rural households. We grouped households into four distinct types according to similar livelihood diversification strategies. For each household type, we identified the dominant income-generating strategies as well as the main agronomic activities pursued. The household types were: (I) households that pursue a cereal-based livelihood diversification strategy (23 %); (II) households predominantly engaged in casual off-farm-based strategy (15 %); (III) households that pursue an integrated livelihood strategy (38 %); and (IV) households with a potato-based strategy (24 %). We then explored the relationship between these household types and improved soil management practices. The results showed that households generating their income primarily by growing potatoes (Type IV) were not only economically “better off” but also more likely to undertake improved soil management practices than those pursuing less economically rewarding, cereal-based (Type I) or casual off-farm-based (Type II) livelihood diversification strategies. This was largely attributed to differences in access to institutional capital that determined the degree of agronomic orientation, rather than household assets, such as age, education level of the head, and family labour. Orienting lower income households toward input and output markets through improving their access to institutional capital may help build livelihood strategies with high-economic return that in turn provide incentives to undertake improved soil management practices. The identified household types may guide entry points for development interventions targeting both food security and agricultural sustainability concerns in the central highlands of Ethiopia. The approach can be applied to different geographical regions with similar livelihood circumstances. Development actors need to take into account the specific contexts of their regions and resources needed to develop a typology when designing pathways for any targeted interventions.

Formation of a stable fibrin clot is dependent on interactions between factor XIII and fibrin. We have previously identified a key residue on the αC of fibrin(ogen) (Glu396) involved in binding activated factor XIII-A2 (FXIII-A2*); however, the functional role of this interaction and binding site(s) on FXIII-A2* remains unknown. Here we (1) characterized the functional implications of this interaction; (2) identified by liquid-chromatography–tandem mass spectrometry the interacting residues on FXIII-A2* following chemical cross-linking of fibrin(ogen) αC389-402 peptides to FXIII-A2*; and (3) carried out molecular modeling of the FXIII-A2*/peptide complex to identify contact site(s) involved. Results demonstrated that inhibition of the FXIII-A2*/αC interaction using αC389-402 peptide (Pep1) significantly decreased incorporation of biotinamido-pentylamine and α2-antiplasmin to fibrin, and fibrin cross-linking, in contrast to Pep1-E396A and scrambled peptide controls. Pep1 did not inhibit transglutaminase-2 activity, and incorporation of biotinyl-TVQQEL to fibrin was only weakly inhibited. Molecular modeling predicted that Pep1 binds the activation peptide cleft (AP-cleft) within the β-sandwich domain of FXIII-A2* localizing αC cross-linking Q366 to the FXIII-A2* active site. Our findings demonstrate that binding of fibrin αC389-402 to the AP-cleft is fundamental to clot stabilization and presents this region of FXIII-A2* as a potential site involved in glutamine-donor substrate recognition.